A new study published in the Journal of the American Medical Association (JAMA) this week showed the accuracy of caloric counts from restaurants is unknown. On the same day, the Center for Science in the Public Interest released its annual Xtreme Eating Awards to eight menu items which may strike fear into the hearts of calorie-counters.

Susan Roberts of Tufts University and her co-authors studied 269 food items and 242 unique foods from 42 restaurants. The foods and restaurants were randomly selected from quick-serve and sit-down restaurants in Massachusetts, Arkansas and Indiana between January and June 2010.

While the researchers found that stated energy contents of restaurant foods were accurate overall, there was "substantial inaccuracy" for some individual foods, with understated energy contents for those with lower energy contents.

About 40 percent of the foods had more calories than what was listed on menus. Of the 269 food items, 50 (19 percent) contained measured energy contents of at least 100 calories or more than the stated menu contents.

Either aiding or aggravating dieters, the Center for Science in the Public Interest, an independent
nonprofit consumer health group, has given chain restaurants its annual Xtreme Eating Awards since 2007. The list highlights the most calorie-heavy "dishonorees," which were unveiled in the current edition of the Center's Nutrition Action Healthletter.

Jayne Hurley, senior nutritionist at the Center for Science in the Public Interest, said restaurants are taking "over-the-top" to a new level. "These are yet more examples of how restaurants are making bad food even worse."

Hurley said she is seeing more of the "stacked, stuffed, and topped" phenomenon – taking food and layering more salt and fat already into high-calorie foods.

"We're hoping that if everything goes as planned in the healthcare legislation, these restaurants would be forced to put calories on the menu. If diners want it, it's there. If they don't, they can just ignore it," she said.

Judith Stern, professor of nutrition at UC Davis, also said she hopes caloric information about foods becomes more immeditely available. When she does know a menu item has too many calories for her liking, she said she often shares restaurant portions with her dining companions, or asks the kitchen to cut her order in half.

"If you want to have something extreme, you can make that decision," Stern said. "But it's really hard if you do it in a vacuum because then you overeat."

The 8 Xtreme Eating Awards were given to the following menu items:

Cold Stone Creamery: PB&C Shake

Calories: 2,010

Saturated fat: 68 grams

Sodium: ??

A "Gotta Have It" PB&C Shake (peanut butter, chocolate, and milk) has a full day's calories and 3½ days' worth of sat fat into each 24 fl. oz. plastic cup, Hurley said.

But Stern cautioned that the 2,000 calorie recommended daily diet is just a guideline.

"Men in general typically need more, and forget about teenage boys," she said. "Women can do less than 2,000 calories if they're older. But all bets are off if you are active."

The Cheesecake Factory: Ultimate Red Velvet Cake Cheesecake

Calories: 1,540

Saturated fat: 59 grams

Sodium: ??

Hurley said that each slice of cake, which the Center said averaged close to three-quarters of a pound, has three days' worth of saturated fat. Hurley said only the Reese's Peanut Butter Chocolate Cake Cheesecake has more calories (1,610), though its saturated fat falls 18 grams short of the Ultimate's.

The Cheesecake Factory: Farmhouse Cheeseburger

Calories: 1,530

Saturated fat: 36 grams

Sodium: 3,210 milligrams

Stern said she was not surprised at The Cheesecake Factory's double awards this year.

Hurley said each serving of this pasta was four cups at the Applebee's they visited. She said each serving includes 1½ teaspoons of sodium (3,700 milligrams), which is like eating two of Applebee's 12 oz. Ribeye Steaks plus a side of Garlic Mashed Potatoes.

The Great Steak: Extra-Large King Fries

Calories: 1,500

Saturated Fat: 33 grams, with cheese, bacon and sour cream

Sodium: 4,980 milligrams

While the extra-large King Fries isn't available at all locations, those who do partake are eating the equivalent of three McDonald's Quarter Pounders with Cheese and two-thirds of a teaspoon of salt, said Hurley.

Morton's: 24 Oz. Porterhouse Steak

Calories: 1,390

Saturated fat: 36 grams

Sodium: 1,200 milligrams

"Too, too much," Stern said. "The steaks are fine. They use excellent meat but that's over the top with the portion size. Bring four of your friends."

That grand total: 2,570 calories, 85 grams of sat fat, and 2,980 mg of sodium, which does not include complimentary bread and butter.

Denny's: Fried Cheese Melt

Calories: 1,260

Saturated fat: 21 grams

Sodium: 3,010 milligrams

Denny's menu describes its Fried Cheese Melt as "four fried mozzarella sticks and melted American cheese grilled between two slices of sourdough bread." It is also "served with wavy-cut French fries and a side of marinara sauce."

Although without the side of fries and marinara sauce, Denny's Melt has 790 calories, 17 grams saturated fat and 2670 milligrams of sodium.

IHOP: Monster Bacon 'N Beef Cheeseburger

Calories: 1,250

Saturated fat: 42 grams

Sodium: 1,590 milligrams

IHOP describes its cheeseburger as "Hickory-smoked bacon is blended right into the beef to make our burgers juicy and delicious with bacon flavor in every bite."

Hurley said the sides can range from fresh fruit (80 calories) to onion rings (620 calories).

The restaurants also wanted a say about their foods:

Cold Stone Creamery said it "provides super-premium ice cream to guests looking to indulge and enjoy the Ultimate Ice Cream Experience. We offer all of our shakes in three sizes, so the largest size of the PB&C shake equates to a high calorie dessert. For consumers that would like a sweet treat with less calories, we have several options such as our Sinless Ice Cream and Non-Dairy Sorbet, and now nationwide all stores will carry at least one flavor of low-fat frozen yogurt that starts at 34 calories an ounce. We strive to provide options for customers that are looking for an indulgent treat that they can enjoy in the moderation that suits their lifestyle."

Patrick Lenow, spokesman for IHOP said, "Consumers value choice and are increasingly equipped with the information and knowledge they need to make appropriate choices for themselves. With more than 30 menu items under 600 calories, along with more indulgent choices, we offer the great tasting foods guests seek while being responsive to their individual dietary needs."

Applebee's, which has been the only restaurant chain to feature Weight Watchers endorsed menu selections, also went on the defensive.

"Applebee's guests want a variety of options, and with access to nutritional information online and in the restaurant, they can make the most appropriate choices for themselves," Nancy Mays, spokesperson for Applebee's, said. "We offer a lot of great-tasting dishes, including six Unbelievably Great Tasting and Under 550 Calories selections and five Weight Watchers-endorsed entrees."

The company also said its "Unbelievably Great Tasting and Under 550 Calorie" menu, launched in January 2010, has been its best-selling menu for two months this year.

John Dillon, vice president of marketing with Denny's, said the restaurants offer a "wide variety of menu items that meet the broad range of preferences and cravings of our guests, including a full complement of healthy, low calorie meals."

"In fact, we recently launched a new "Fit Fare" menu that includes four different types of lighter options, including Fit Fare Light for less than 550 calories, Fit Fare Lean for under 15g of fat, Fit Fare Protein for over 20 grams of protein and Fit Fare Fiber which contains over 8 grams of fiber," Dillon said in a statement. "Our guests want variety and our menu provides that to them."